Dental Questions

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This page has been created as a question and answer page for anyone with dental questions. Dagon H.C. Jones, DDS will check this page periodically and answer general questions about dentistry that anyone may have.

The advice and information given here are strictly for entertainment purposes only. Please understand it is impossible for any healthcare provider to diagnose or treat any condition via a wiki.

This page is intended for questions about dental procedures, dental science, and dental materials, but not for questions about billing and insurance. Questions about billing and insurance should be addressed to your dentist's office or insurance company.

Questions about fluoride? See Water Fluoridation

Other dentists in the community are welcome to respond to questions as well.

  1. Options for Replacing Missing Teeth
  2. Digital X-Rays
  3. Periodontal Disease
  4. Sealants
  5. TMJ/TMD
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Please ask away!

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2008-04-18 08:07:17   This page has been here for a while, someone must want to know about dentistry. Am I the only one that thinks this stuff is cool? —DagonJones

2008-04-18 11:06:01   Okay, I will ask something. I need to get a bridge because I am missing tooth #4. What is the procedure like? How long does the bridge last? What can you tell me about cost? —CalamityJanie

Options for Replacing Missing Teeth

2008-04-24 15:25:56   Well first off you have several options for replacing a missing tooth. Usually the best option is a dental implant. After a tooth is extracted the bone in the area will slowly resorb or dissolve away because the bone no longer receives a chewing stimulus from the root of the tooth. This often does not pose a problem for maybe 25-35 years. A dental implant will maintain the density of the bone in this area because it acts like a tooth root. An implant is intended to be permanent, they have only been around for about 25 years but all research suggests that they will last for the life of the patient if properly cared for. Implants have a very high success rate (around 97% in the #4 area). A single implant is often only about 15-20% more expensive than a bridge. A bridge is used to replace a missing tooth by placing a crown on each adjacent tooth with a false tooth (called a pontic) in between the two crowns. I usually only recommend a bridge if the two adjacent teeth would benefit from crowns. It is unfortunate to have to shave down healthy teeth to make a bridge. Having said that a bridge can be an excellent way to restore a missing tooth. They feel natural but because the three teeth are now fused together you will not be able to floss normally between them and you will need to use a special tool called a floss threader to clean under the bridge. Bridges tipically last 15-20 years but can often last much longer if done well and cared for. Eventually the bone around #4 may resorb away enough that the existing bridge does not look very nice anymore and needs to be replaced. Or the bone resoprtion may (this is rare) compromise the adjacent teeth. A bridge is often billed out as the same as 3 crowns, so the price in Davis may be anywhere from $2400-3200 depending on the materials used and the dentist. A bridge takes at least 2 appointments, one to prepare the teeth for a bridge and place a temporary (This appointment can last 1.5-2.5 hrs), then you will have to return in 2-3 weeks to have the custom lab made permanent bridge cemented (0.5-1 hr appointment). An implant will likely cost about $3500-4200, once again depending on the dentist and materials used. An implant is a more involved process than a bridge and often takes 4-7 months before it is completed (this assumes the extraction site of #4 has completely healed). Ussually another doctor, typically an oral surgeon or a periodontist, will place the implant and your general dentist will restore it with a crown. The whole process takes 4-5 apppointments most of which are very short and painless. Hope this helps, I am happy to answer other questions you have. —DagonJones

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2008-04-25 10:30:09   Thank you for the detailed explanation Dr. Jones... I have been undecided between an implant and a bridge... I guess I thought a bridge would be much cheaper but it seems to have its downside if it doesn't last as long. And I also agree that it would be a shame to pare down the teeth so drastically on both sides of the missing tooth. When I saw illustrations of that online, it made me kind of sad, I just can't explain it. I had a periodontal procedure about 2 months ago, and Dr. Shirazi presented me with the opportunity to just have the implant done at the same time but I chickened out, and at the time, I still thought a bridge would be better. Well, I guess I can go back. I have braces currently but he said he has barely enough space for the implant to be placed. —CalamityJanie

2008-04-25 10:46:39  You are very welcome. If you are currently wearing braces, you most likely have the opportunity to move the teeth to make more room for an implant, talk to your orthodontist and have your orthodontist and Dr. Shirazi discuss the options. Of course there are other options for the missing #4, including doing nothing (which I dont recommend because the adjacent teeth are likely to shift into the open space). Other options are limited to different types of removable appliances that you would have to take out at night. Most people dont prefer removable appliances but they are more cost effective. —DagonJones

2008-04-29 14:39:37   I've got two main questions. The first is regarding the effectiveness and the relative radiation exposure between conventional film based x-rays vs digital x-rays. The next is regarding "Diagnodent" and similar laser based tools. I just don't know much about what this can be used for, and am wondering if it might be something I'd be interested in.

Thanks for setting this page up, and thanks in advance for any feedback,

—Brett

Digital X-Rays

2008-05-01 13:56:57   Great questions because I know there is a lot of “buzz” about digital x-rays (radiographs) and laser caries detection. First off lets discuss x-ray films, dental x-ray films come in 3 speeds, D, E, and F speed. F speed is the most sensitive speed and therefore requires less radiation exposure than the other two films. “Results reported in literature illustrate that switching from D to E speed produced a 30-40% reduction in exposure. Switching from E to F speed produced a 20-25% reduction in exposure, and switching from D to F-speed film produced a 60% reduction in exposure”. The above quote is from an article by the FDA located at [WWW]http://www.fda.gov/cdrh/radhealth/dentalradio.html F speed film is newer and therefore more sensitive, there is little difference in image quality between D, E, and F speed films. Most modern dental offices that do not use digital radiographs use F speed film. I don’t know the exact reduction in radiation exposure by switching from F speed to digital radiographs but I have heard it reported that the difference between D speed and digital is a 90% reduction. So the difference between F speed and digital is probably 20-30% reduction. In my opinion (which is shared by most dentists I speak to) conventional film produces a clearer image, which makes diagnosing decay easier. However digital films are much quicker, easier to transport, and have slightly less radiation exposure to the patent.

The radiation exposure from a full mouth x-ray series (approximately 18 films) is roughly equivalent to the same exposure the average American receives during two days of daily life (exposure from solar radiation, radon gas, etc). I consider the difference in radiation exposure between F speed film and digital radiographs small enough that it is not significant.

Regarding laser caries detection I will discuss the Diagnodent because it is the only device that I am familiar with and understand the technology. Similar devices exist on the market but I cannot comment on their effectiveness. A diagnodent works by shining a laser into the pits and grooves of a tooth to detects bacteria. Many oral bacteria have molecules in their cell membranes that fluoresce (give off light) when exposed to a particular wavelength of laser light. The Diagnodent measures this fluorescence and gives a number reading and an audible tone. More bacteria produce a higher pitch on the audible tone and a higher number readout. The instrument is sensitive enough to detect small levels of bacteria that do not need a filling so the number readout is important. A number of 30 or above has definitely broken through to the deeper part of the tooth and needs a filling. Numbers from 20-30 are questionable and depend on the visual presentation and the patients decay risk, therefore these are left up to clinical judgment. I have been very surprised by how deep some decay is that otherwise looked and felt normal on the surface. Heavy and dark stains in the grooves of the teeth are an indication of possible decay. For more info on this type of decay see my entry in the comments section of the Dental Fraud page.

The Diagnodent is a great tool to help detect decay that is lurking deep in the pits and grooves of the teeth that would otherwise not be detected. However it is just a tool and the dentist has to understand its limitations. A Diagnodent cannot detect decay in-between the teeth and cannot be used next to an existing composite (tooth colored) filling. A Diagnodent will give a false positive if there is heavy plaque or tartar in the grooves so those grooves need to be clean. Also if a Diagnodent is used after a cleaning and the hygienist has used any colored agents (special toothpaste or plaque staining dyes) the Diagnodent may get a reading from the pigments in the dye and give a false positive. Remember that just because the Diagnodent is giving a reading, does not mean that there is decay that needs a filling.
I hope this info was helpful and I am happy to answer other questions. I would not let digital radiographs or use of a Diagnodent be a deciding factor when choosing a dentist. There is a lot of new technology in dentistry but none of it is a replacement for good clinical judgment, skill, and compassion.

2008-11-09 15:40:27   Great page, Dr. Jones. My question isn't about dentistry exactly, but more about low-cost dental services in Davis. Are there low-cost options for dental care in Davis, e.g. for those without coverage needing a filling? —robinlaughlin

2008-11-10 10:08:25   If you are a Yolo county resident and meet certain income requirements you can go to the Davis Community clinic "Communicare Heath centers" which is behind sutter hospital. There are 4 Communicare dental clinics in Yolo county, Davis, Woodland, West Sacramento, and Esparto. The Davis dental clinic is open Tuesday-Friday. 530-757-4667 call for more info. You will need to go into the clinic and fill out an application. They also accept Medi-Cal. If you are having an emergency you can come in at 8am or 1pm (sharp)for an emergency appointment, there is no guarantee you will be seen that day but if there is enough time you will be taken care of. I volunteer there once a month on Thursday nights so you may see me there. Communicare is a good resource but they are underfunded and have such a huge patient base that there is often a very long wait for appointments. Be prepared to provide documents to prove your residence in Yolo county and your income.—DagonJones

2009-05-17 22:20:45   My teeth have severe enamel erosion. The tips of my front teeth seem a bit translucent, and they're very sensitive. I want to find a way to remineralize, however there are two different ways that are confusing me. The first says to use toothpastes like arm and hammer enamel care with ACP. This also contains fluoride, and glycerin. I've heard that glycerin will coat the teeth, and prevent remineralization. The second method is to use all natural, fluoride, and glycerin free toothpastes. Right now I'm trying the Green Beaver brand. This has silica, and sodium bicarbonate, as well as vitamin C, which they claim helps strengthen teeth, and gums. Which of these methods is the correct way to remineralize? Does glycerin containing toothpastes really inhibit remineralization? Which would nullify the benefits of ingredients like liquid calcium, xyitol, and novamin. —bluevelocity

2009-05-18 13:16:45   I do not know if glycerin inhibits remineralization. Logically, I dont see how it could, because if it does leave a film on the teeth, it would be a water soluble permeable layer. The teeth naturally form a permeable protein layer on top of them called the "pellicle", minerals can freely move through this layer to remineralize the tooth surface. To address your question more generally, I dont think remineralization will help your problem. Remineralization refers to restoring minerals to demineralized enamel, this changes the enamel from being weak and soft to hard and durable. However, remineralization can not restore lost tooth structure or rebuild lost enamel (not to a visible extent, only a microscopic one). When acid (either dietary or from bacteria via carbohydrate metabolism) attacks tooth structure it pulls out minerals (demineralizes the tooth). Your own saliva is very good (better than any toothpaste) at providing a super saturated environment of minerals to help remineralize demineralized tooth structure. If demineralized tooth structure suffers a prolonged acid atack it will be destroyed, ussually resulting in a cavity.

You can address the sensativity by using a sensativity protection toothpaste, like sensodyne, but these often do not work all that well. You can use a professional product (only available through a dentist) called MI paste. This is the one product that may be better at remineralization than your own saliva. It prevents sensativity by blocking the microscopic tubules that are in exposed dentin. It can be applied at home and needs to be used for several weeks but generally has very good results.

Regarding the translucent incisal edges, if the enamel is very thin on those teeth you may want to consider having tooth colored composite filling material bonded on to the edges to reinfoce them. Or you can have the thin edges "sanded" off by a dentist. —DagonJones

2009-05-18 15:17:26   Floss first, and then brush; or brush first, and then floss? —TheAmazingLarry

2009-05-21 11:59:47   So, I usually wake up with a thick almost gummy white film on my teeth. Is this plaque or is it this "Permeable protein layer"? —MasonMurray

2009-05-21 19:17:43   The film on your teeth in the morning is definitely plaque, you cannot feel the pellicle, it is only a few microns thick. According to the reseach I have read and how I was taught in dental school, it does not matter what order you brush and floss. But it is VERY important that you do floss daily.

2009-05-21 19:42:25   Plaque is a bacterial biofilm. It's what you gotta take care off every day. If you don't, it'll eventually lead towards cavities and mineralize up to turn into calculus/tartar, which brushing won't remove (but your dentists sharp thingies are meant for). —EdWins

Periodontal Disease

2009-05-22 23:15:28   The reason flossing is so important is that it removes the plaque between the teeth that brushing alone does not. This plaque can lead to cavities between the teeth or gum disease. The area between the teeth includes the area below the gumline that is between the teeth, also known as the periodontal pocket. This diagram shows a health pocket on the left and a pocket with periodontitis or periodontal disease on the right. Because the pocket area is a low oxygen (anerobic) environment, lots of nasty bacteria can breed there. Over time they produce lots of toxins, your body responds by producing inflamation (redness, swelling, bleeding etc.) Both the bacterial toxins, and your body's own response causes atachment loss, where the gum tissue atachment point migrates downwards, this creates a deeper pocket which is harder and harder to clean and can harbor more bacteria. the presence of atachment loss in the pocket area is ussually the diagnosis of periodontitis. As the gum tissue attachment point migrates downwards, the bone will follow becuase it always wants to maintain a certain distance from the gum attachment point. Periodontitis can result in rececession, which is when the gums visibly move downwards exposing the root surface. There are many other causes of recession, such as vigorous tooth brushing with a hard or medium bristle toothbrush (always use soft or extra soft, they clean just as well) some recession can come with age. Once recession has occured it can only be repaired with a gum graft. The proper treatment for gum disease is scaling and root planing (aka a deep cleaning) this is where tartar and bacteria are removed from below the gumline with specialized instruments (your gums are ussually numbed up for this). Ussually some of the gum tissue will re-attach to the root surface after the scaling and root planing, but because the bacteria can migrate back into these areas, periodontal maintenence cleanings are ussually recommended 3-4 times a year. It takes about 3 months for bacteria to build up the colonies and enviornment required to cause progression of gum disease. Even if there is no re-atachment to the root surface, if there is a reduction in the inflamation, then the severety of the disease has been reduced. —DagonJones

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health on left, periodontitis on right

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Recession on left, normal on right

Regarding mouth washes, there are a wide variety of mouthwashes that are designed for different purposes. Some, like Scope, are just to freshen breath. Others, such as ACT or Fluoriguard have fluoride and help prevent cavities. Listerine helps fight gingivitis and gum disease. There is a prescription mouth rinse that kills bacteria responsible for decay and gum disease. I have never heard of mouthwash leading to thrush (or Candidiasis) but I can see the logic behind that because if the micro organism ecosystem in your mouth is disturbed it can allow Candida, a fungus, to proliferate and take over leading to thrush. However, I wouldnt worry about mouthwash causing thrush, I think that is pretty unlikely.

Wow great questions you guys, this is fun!

2009-05-23 10:15:40   Hey, out of curiosity and since you like the questions, here's a family medical oddity. My father's family is prone to never getting some of their adult teeth or getting them very late. My grandfather was x-rayed over and over during WWII by dentists because they were curious about it. I still have some teeth that never changed (premolars, and thankfully they look fine), I didn't get my second molars until I was in my mid 20s, and my wisdom teeth came in (straight and true) five years later. My father and his siblings all have some of their original teeth as well. As a side note, we're all pretty durn cavity free, other than my brother who lost all his baby teeth for adult teeth and had his molars come in at the usual times. I've always wondered how common this is. Have you run across it before or have you ever heard of it? —JabberWokky

2009-05-28 12:48:00   It is very common to have congenitally missing teeth run in families. There does not seem to be any specific pattern, like skipping generations, mother's side of the family, or anything like that. However, it is most commonly bicuspids and lateral incisors that tend to be absent. Ussually people do just fine with the baby teeth but sometimes they will fall out becuse they have shallow root structure or they can also start to resorb (melt away) which may necissitate an extraction. Regarding your second molars (aka 12 yr molars) comming in late, that sometimes happens but to the best of my knowledge it is not related to the congenitally missing teeth. —DagonJones

2009-05-28 18:49:35   Even stranger, I actually had a 3rd set tooth try to come in. I had it surgically removed because it was not properly formed, but my great-grandmother had the same thing.... Odd how it sometimes skips... er... 3 generations? —MasonMurray

2009-05-30 19:17:40   Question: My 6 year old sons "upper right lateral" baby tooth was knocked out @ Kindergarden running around—this was in October. Anyhow, we had it x-rayed and the dentist said we will have to see what happens. The "upper left lateral" tooth fell out and it's just emerging through now. I'm thinking then, his upper r. lateral would also be emerging around this time; but it's not. I felt both sides of his gums and on the right, it feels and also looks like it tooth is kind of stuck up there?? It doesn't feel the same on the left. Is there anything that can be done if the tooth is not coming down? —JRaumer

2009-05-30 22:33:07   I have a temporary crown right now and will get it replaced with a permanent one in a week and I was wondering how durable the permanent crowns are. —hankim

2009-05-31 22:04:46   JRaumer: Your son's tooth is likely to be just fine. the contralateral (other side) teeth rarely come in at exactly the same time, they are often seperated by about 6 months or so, sometimes longer sometimes less. If a primary tooth(aka baby tooth) is knocked out then there is potential for damage to the developing adult tooth, but this is very rare and unlikely. If it looks and feels like there is a tooth under there then he is probably in very good shape, often times there is a very pronounced tooth shaped swelling for several months before the adult tooth finally erupts through the gums.

hankim: A permanent crown is genarally designed to last a lifetime, however, there are many things that can cause a crown to need to be replaced. Decay, excessive wear, tooth fracture, can all necissitate replacement. The average ( and this is a very rough estimate) life of a crown is about 20 years. depending on why the tooth needed a crown in the first place plays a big role in the long term life span of a crown as well. If the tooth had very extensive decay or has a root canal then the life expectancy is less. —DagonJones

2009-06-10 18:01:11   I have a few questions about kids and teething: At what age should youngsters start going to the dentist? And, how do foods affect dental and jaw development throughout the deciduous teeth period? ——related to this last question, I've heard that eating lots of HARD foods (granola, etc) as a kid will result in straighter and stronger permanent teeth later on. Is there any truth to that? —TheAmazingLarry

2009-06-11 13:12:05   Children should see a dentist by age 1. When kids are very young we do a visual exam to check for signs of decay or other oral health problems. We also review proper brushing and flossing techniques for parents, discuss fluoride, diet, etc. from ages 1-5 I ussually recommend an exam once a year, unless the child has a high risk for decay then I recommend every six months. I have never heard of hard foods leading to straighter and stronger teeth, and I cant see how they could. This sounds like an "old wives tale" to me. The position of adult teeth can be influenced by the position of the deciduous (baby) teeth; however, the chewing forces on the baby teeth would have no effect on the development or position of the adult teeth. Tooth development can be effected by systemic factors like a very high fever or certain medications such as tetricycline (which causes gray stains on teeth), but indirect forces would not effect the cells responsible for tooth formation. Heavy chewing forces could lead to more dense bone around the baby teeth because bone is a very dynamic tissue and is responsive to physical forces. Bottom line is hard foods are not needed or recommended for proper tooth development.—DagonJones

2009-07-16 14:01:07   One of my teeth-premolar upper has slight split from one side. Is is straight down split. It doesn't bother me much except I eat too hot or too cold. My dentist was suggesting me to have a drill and fill it. I am very much cautious about my teeth and I am afraid to do the drill thinking that it will make my tooth worse coz my dentist was saying that she will make a horizontal drill and make up the split portion with fill. I am also scared that while making a horizontal drill on my teeth, she may be hurting my next teeth adjacent to it. I would like to get your opinion- Shall I go for Drill and Fill or just let it stay and avoid eating hot and cold stuff.

Sorry for the late reply. I doubt your adjacent teeth will be harmed by the drilling, if it is a vertical crack on the cheek side of the tooth it would be very hard to damage the adjacent teeth. For most fractures I would actually recommend a crown as opposed to just a filling. If the tooth is sensative to cold, and sensative when you bite down then the tooth almost definitely needs a crown. Fractures in teeth can spread pretty easily once established and they can lead to cusp fracture or sometimes root fracture. If there is a fracture in the root, then the tooth will need an extraction. It is very hard to say without actually examining your tooth, but I would not recommend doing nothing. If the tooth is sensative and there is visual signs of a fracture you should definitely have the tooth repaired. —— dagonjones

2009-08-27 19:21:29   My son is 14 years, 11 months. All his teeth have come in and he is currently in braces. His canines came in late (left canine just finished coming down two months ago) and space had to be created with springs to open room for them. Right now, his right maxillary second molar is primarily retained but the oral surgeon said it should have been exposed much sooner and now he should just wait as it probably won't come down after being exposed. There seems to be nothing in its path and the other three second molars came in fine. Could this be related to tooth b being extracted at 10 years old due to a cavity? Is it likely the second molar will come in after being exposed? —Genny

It would be almost impossible for the late/hindered eruption of a second molar to be related to an extraction of tooth B at age 10. The second molars do not replace any primary ("baby") teeth, therefore, it would be very difficult to damage the developing tooth bud of a second molar during an extraction of a primary tooth. By the way primary tooth B is replaced by the upper right first premolar (#5). Delayed or hindered eruption of second molars does happen sometimes, this can happen for a variety of reasons but often it is difficult to know why. Sometimes they can be moved into proper position with braces but that can sometimes be difficult. I would discuss the case with his orthodontist, ask him directly how likely it is this tooth will come into proper position. —- dagonjones

2009-09-09 11:34:57   I have a question. For all of my life, I've had a tiny black dot that appears to be a tiny hole of some sort on the top of one of my molars. It has never bothered me and I've never had a dentist say a word about it. Should I be concerned about it? —ChristyMarsden

2009-09-10 11:33:41   That tiny black dot is probably one of the pits or grooves that are very common in molars. if the pit is deep enough it can pick up quite a bit of stain. Most likely it is only staining and I would not worry about it, especially if you get regular exams. Sometimes those stains can have decay underneath them, a diagnodent (see above) is a good tool to see if there is decay there but ussually it is not necissary becuase the decay can be detected during a standard exam. —DagonJones

2009-09-10 17:57:26   I had a new crown molded a month ago, and the permanent gold one has been in for two weeks now. Would this change be enough to cause me to start biting the inside of my cheek when I eat? I started noticing this once I got the permanent crown put in, and today I started really feeling out the area where this is occurring, noticing that the "real" tooth above the freshly crowned one seems to have some deep gouges on the sides. Now this may have been there from a previous filling-I can't really tell as it may be a tooth colored filling, but it did seem like my dentist drilled on the upper tooth while the lower was being prepped for the crown. Did I imagine that, or would there be a legitimate reason for the dentist to do that, OR is the dentist looking to "guarantee" future revenue down the line when I might need a filling or another crown on my last natural molar? —CFletcher

I am going to give some quick answers and hopefully come back to put in more detail later. It is relatively common to adjust the opossing tooth during a crown preparation, this ussually does not damage the tooth but could make it feel a bit rougher, it can be polished if need be (ask your dentist next time you go in). When two teeth meet togeather there is an ideal amount of overlap that prevents the cheek from getting caught between. that can change a bit when a crown is made, it may not be the dentist or labs fault but rather simply the limitations that are present when making a crown. I have encountered this situation a few times, ussually the body adapts and the person "learns" to stop biting, if it is very serious the crown may need to be replaced. I have met many people who have a cheek biting problem with natural teeth with no crowns or fillings. -dagonjones

2009-09-13 17:40:29   Hi Dr. Jones,

On my last appt, the doctor kept calling out 3's, 4's and a few 5's. He said I had "calculus" and needed a deep cleaning. From what I have had described, the deep cleaning will open up the underside of my teeth to the outside permanently. And, because of this I will be stuck going back 3 to 4 times a year. This frightens me because it 1) opening me up to the outside world sound like it will do more hard than good and 2) since I do not have the ability to go back 3 to 4 times (or ever once a year), if I have this done and can not keep going back over and over and over I will be really, really screwed. Please tell me I am wrong? What do you recommend?
-T —ToddAndMargo
It sounds like you have periodontitis (gum disease) see the above entry :2009-05-22 23:15:28 Peridontal Disease for more info about gum disease and its treatment. Calculs is just another word for tartar, it needs to be removed because it is like a playground for bacteria. The deep cleaning will only remove bacteria and calculus from the tooth root. It will not expose any part of the tooth to the outside that was not already exposed. I think you should really commit to cleanings at least 3 times a year (even if your insurance does not cover all of them), and the deep cleaning (root planing), it can really make a big difference. The long term results of gum disease can be tooth loss, also untreated gum disease can increase your risk of cardiovascular disease, stroke, and type II diabetes. The 3's are not bad and the 4's are marginally bad, the 5's are definitely indicate the presence of gum disease, but it is not just the numbers but the severety of the inflamation present in the gums. Inflamation is indicated by redness, bleeding, and swelling of the gums—dagonjones

2009-09-13 17:56:20   Hi Dr. Jones,

I lost a lower front tooth in a car accident about 40 years ago. I have a lot of bone loss in the empty space. If I can ever afford an implant, I will need bone replacement. Can this be done with ACP (amorphous calcium phosphate) or similar? Or, am I stuck with surgery?

If surgery, where do they get the bone from? And, what effect will stealing the bone have on the site where it was stolen from?
-T —ToddAndMargo

Bone is ussually deminieralized cow bone or human bone from a tissue bank, both of which have NO risk of transmission of disease. If bone is harvested from your own body (which has the best chance of success but also the most uncomfortable) then the donor site will take a while to heal and ussually hurt but it will heal just fine in the end with almost no chance of permanent damage. The bone would ussually come from your leg or your jaw. The bone graft is considered surgery, but you will not likely need surgery to harvest bone becuase most bone grafts today use material from a tissue bank. —dagonjones

2009-12-02 10:12:08   My molar broke last night (on a Tues). A piece of it the broke off and seemed to crumble. I left a message for my dentist, but alas, her office is closed on Wednesdays. I'm flying out of town on Friday. What's a person to do? —NoelBruening

No number given. —Noel

If your dentist does not leave an emergency number just find a dentist who is available that day, Davis is full of great dentists who would be happy to help you out. Most dentists will do a temporary fix for you to last you long enough to get back to see your regular dentist.

2009-12-21 09:10:23   I have a worn out gold crown on a back molar. A couple of local dentists said they would replace it with a $450 stainless steel crown. Other say pretty much over their dead body, but would not give a reason. One says stainless is stronger and last longer, they just look bad. Since it is too far back to see, I do not care. Is there some reason to stay away from stainless and pay the $1100 for a gold crown? —ToddAndMargo

2009-12-22 10:09:24   I would strongly recommend against a stainless steel crown. Stainless steel crowns are pre made and come in a variety of sizes, none of which will provide a precise fit for your tooth. Stainless steel crowns often (almost always even in the hands of great dentists) have very rough margins. These rough margins collect plaque and tartar and often lead to decay in the long run. A custom crown is made in a laboratory and should have a very smooth margins with a precise fit that will not allow bacteria to accumulate. If cost is a big issue just keep the gold crown you have, if there is a hole worn through the top a small filling can be put there. This filling may not even be necissary if there is not decay present. Talk to your dentist and find out if the crown absolutely needs to be replaced, it may be able to be patched. A stainless steel crown will be more expensive in the long run because it will not last as long and is much more likely to lead to decay. Stainless steel is a stronger material than gold but the metal is much thinner on a stainless steel crown than a gold one. —DagonJones

2009-12-22 16:24:58   Hi! Lately I have had a lot more tooth sensitivity (cold and hot) in the back of my mouth, one molar on the right side of my mouth. I have a filling there, not too old...am wondering if this is something I need to be worried about? I brush and floss, no bleeding or pain from that anywhere...Thanks! —jsbmeb

2010-01-05 15:34:18   Your sensativity to cold could be many things, It could be a cracked tooth, infected nerve, decay, or nothing at all. Teeth are often sensative to cold, and this can change with time. Teeth with fillings are more likely to have sensativity but even perfectly healthy teeth can have transient sensativity. I would wait several weeks, your cold sensativity will likely subside with time and it may even come back in the future. If it continues to get worse or if the pain is severe and lingers for more than one minute after the cold is removed you should see a dentist. —DagonJones

2010-01-06 10:15:20   Hi Dr. Jones... This problem has been bothering me for years—I have a impacted wisdom tooth in my lower jaw (mesial impaction? as seen here except it is fully erupted):

http://img46.imageshack.us/img46/8751/pmesialimpaction.gif

I had already spent quite a lot of money a few years ago getting oral surgery to lift and straighten it, but it failed. I've been keeping it clean and so far by flossing and brushing excessively and have not had any cavities in the impacted area yet, but often times I get pain in my jaw and pressure-build up and aches...

I was wondering what my options are? Can it be fixed, or must it be removed? If I get it removed, will I need to remove the corresponding tooth on the jaw above it (I'm reluctant to remove one tooth, yet alone two)? Thanks in advance! —H4rry

2010-01-14 08:55:24   What you are describing is probably "pericoronitis" which simply means inflamation around the crown. It is a common problem with lower wisdom teeth. because the gum tissue sits very high around the tooth plaque, bacteria and food often get caught below the gum and lead to infection, inflamation and pain. The best solution is almost always to remove the tooth. The inflamation can be treated every time by topical antibiotic rinses or debridement (cleaning under local anesthetic) or sometimes recontouring of the gum tissue. I would not recommend these methods because the problem will ussually continue to recur.

2010-01-20 19:43:58   I have two questions. I got braces when I was ten and had them for three years. But once I got them removed I didn't use my retainer because it didn't fit properly, it would pop out. A couple of years later when I went to a different dentist, I was told that because I had braces at a young age the root of my two front teeth are short and weak. My first question is, can getting braces at an early age really do that to the root of the tooth and is the effect reversible? My second question is, because I stopped using my retainer right after the removal of my braces, I have crooked teeth again. I want to get braces again, preferably a removable aligner, but will it further damage the roots of my front teeth? And thanks in advance. —XuJeong

2010-01-25 22:49:09   During orthodontic movement the roots of teeth can become resorbed. It is more likely for this to happen when the teeth are being moved very rapidly (which was not likely the case if you were in braces for three years) , but it can occur during regular orthodontic movement. Unfortunately the effect is not reversable. It is possible to move your teeth again with braces but the chances of further resorption are present and depending on the severety of your resorption it may not be recommended. You would have to check with an orthodontist. The orthodontist would evaluate your x-rays and the severety of crowding and let you know how significant the risks are.

I emailed this question to Dr. Molitor (a local orthodontist and all around nice guy) here is what he had to say:

"These are good questions. There is no evidence that braces at an early age causes increased root resorption. As a matter of fact the opposite seems to be true. That is, orthodontic treatment on the very young rarely produces root resorption. It is true however that orthodontic treatment for younger kids often implies prolonged or multi-phase treatment which can be related to increased risk of root resorption.

For those that have already experienced root resorption, further orthodontic treatment definitely can be risky. The decision to do orthodontic treatment is always a balance of risks and benefits so it would depend on how much the teeth need to move, how much root is left on the affected teeth, and how much the "crooked teeth" bother you. "

Hope that helps.
Matt Molitor

2010-02-03 12:45:23   Any advice for somebody about to see a dentist (for a cleaning) for the first time in over 20 years? I've never had any problems (straight teeth, including wisdom teeth that came in fine and are accessible for cleaning, never had a cavity, etc), but I figure there might be some questions I should ask or something like that. Other than some back of the tooth staining from coffee and tea, I have no issues I can even think of. I should also add that I don't have any fear of dentists at all; I have just been a business owner for many years, and I didn't have dental insurance until I got married, and then didn't think about going until my wife pointed out that with our upcoming move, we'll be changing insurance, so I might as well take advantage of what we've been paying for and go now. —JabberWokky

2010-02-03 20:28:06   Very informative page. I have been considering a dentist but will need time to consider it, however, partly due to personal interactions and partly due to seeing the extremely positive reviews I think I would definitely have visit Dr. Jones. —WesOne

2010-02-03 21:24:40   When you see a dentist make sure they check your periodontal (gum) health. This step is known as perodontal probing, it involves the dentist or hygienist feeling your gums and counting out a series of numbers. See the entry on this page dated 5-29-2009 for more details. If it has been a long time between cleanings there is likely a good amount of calculus (tartar) buildup on your teeth, which has likely led to inflamation or even gum disease (lets hope not). Dont feel swindled if the dentist wants you to come back for 2 or more cleanings, if there has been tartar on your teeth for more than 20 years it can be very hard to remove and sometimes it takes longer than 1 hour to get it all. If you have other questions after your first visit let me know, you can email me the x-rays and I will be happy to review them and give you my advise. —DagonJones

2010-02-09 10:52:57   What's your general feeling on sealants? I was always a very good brusher and had no cavities until late college. In high school my dentist insisted on sealing my teeth, which my mom (a former hygenist) was not very happy about because she feared they'd eventaully crack and leak, thus trapping things under the sealant. Given a sudden onset of cavities (probably 10 surfaces in 4 years) with no other changes in brushing, flossing, or visiting a dentist, is it possible the sealants were not such a hot idea? Thanks in advance. —AmLin

Sealants

2010-02-09 14:15:13   I recommend sealants based on the risk of decay for the tooth. If a person has a history of decay and the tooth has very deep pits and grooves, then a sealant is a very good idea. For kids under 10 sealants are usually recommended on the adult molars because kids commonly have a higher risk for decay (love of sweets and lack of good brushing). For a good sealant the tooth must be kept very dry during placement, if moisture gets on the tooth during the sealant process the sealant won’t bond well and it could leak. The grooves should also be very clean, it is best to clean out the grooves with a very small drill, a microblaster ( a very small sandblaster), or a spinning brush with pumice. If a sealant is placed well it will last a long time and the risk of getting decay under it is very slight. If a sealant is not bonded well then plaque can get under the seal and lead to decay. If decay is sealed in under a sealant when the sealant is placed, the decay won’t spread (if it is completely sealed) because the bacteria can not get a carbohydrate food source. Overall, sealants are a very good thing; they do much more good than harm. However, they can be a problem if they are not sealed well but this is usually rare.

2010-02-09 15:57:09   I have a cap on one of my upper molars, about two years old. Part of the cap is metal (amalgam, perhaps? not gold). Normally it doesn't bother me, but when I swim in the pool, sometimes I get an uncomfortable "metal" feeling. Any idea what could be causing that? Chlorine? Exercise? I'm clenching my teeth while swimming? Should I be worried about it? —CovertProfessor

2010-02-09 19:47:34   The metal is most likely noble white gold. Similar to the white gold in jewelry. It has a silver appearance in is commonly used in porcelain fused to metal crowns (aka caps). The sensation you are feeling is probably due to clenching your teeth while swimming, I would try to avoid that. Too much force on teeth can cause sensitivity. I would not worry too much about it, it is very common for teeth with dental work to be a little sensitive from time to time (this even happens on teeth with no dental work). I would only worry if it was painful very often (like once or twice a day) or if it started to get increasingly worse. —DagonJones

2010-02-20 15:04:50   Is it possible to induce temporary sensitivity via a ton of sugared candies? —StevenDaubert

2010-02-20 15:44:36   About four years ago I had corrective jaw surgery to fix an open bite. Now my jaw regularly locks and has to "pop" open, which sounds like a loud crack. Is this a normal complication from the surgery, or is it potentially unrelated? —MHaymond

TMJ/TMD

The following is a general list of recommendations for jaw pain (TMJ/TMD):

2010-02-22 11:19:59   So years ago... I got into a pretty bad car accident. Ever since, I've had this jaw popping thing happen whenever I open my mouth big to yawn or the like. It's as if the right side of my jaw unhinges itself and slides to the side ever so slightly. Never caused any pain, but lately I've been waking with an ache on that side. How do I fix that? —Aaron.Curtin

What probably happened to you Aaron is that one of these muscles or ligaments on the right side was torn and did not heal exactly the same as before. So now when you open on the right side the disc slips out of position (resulting in a pop or click). Also your jaw may be translating further on the right side resulting in your jaw moving a bit to the left. The pain you are having on the right side in the mornings is likely due to night time grinding or clenching of your teeth (aka parafunctional habits). These movements can create a lot of stress and strain on the muscles and the joint, resulting in soreness. I would guess that you have had an increase in stress in your life (stress often makes jaw discomfort worse). You could try some of the things listed above (minimize stress, minimize hard/chewy foods, thermal compresses). If your symptoms persist or get worse you should see a dentist, it would probably be best for you to have a custom bite plate made. DagonJones

2010-03-18 14:10:10   During a recent exam I was asked what my daily regimen consisted of: brushing, flossing, etc. One tool that came up that I'd never really thought about was a water pick. I don't use one, and never really thought about using one. I brush and use mouthwash at least twice a day, floss once a day, and have no problems with my gums. Is there any reason to use a water pick as part of a normal daily routine? I've always thought of them as somewhat gimmicky or for people with specific issues. —JabberWokky

2010-03-18 14:23:38   Also during the recent exam, they brought up some non-tooth oriented items. For instance, the fact that my jaw sometimes locks open when I open my mouth really wide (usually in a big yawn), and usually clicks when I open it wide. There's no pain unless it locks, and it happens so seldom that I consider it a non-issue. You've answered the question about the jaw clicking already (although they think mine is because the tendon slides over a bone causing transition). But the question I had after leaving was: how far does the practice of dentistry go beyond teeth? I've always considered it a tooth and gum field. Since they measured my jaw displacement, obviously the jaw hinge is also a common part of the field. Are there any other common non-directly-tooth related problems that one can see a dentist rather than a doctor about (or at least bring up during an exam)? —JabberWokky

2010-03-18 14:26:39   As a third, semi-rhetorical question, is there anything that people commonly do that is worse to the overall health of all parts of your body than using tobacco? —JabberWokky

2010-03-18 16:34:13   If there's only a root, is there another option other than root removal? —BruceHansen

I would have to see the situation; however, there is rarely anything (good) that can be done with just a root. A root canal could be performed on the root then it could be used for retention of a partial denture. —DagonJones

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